Excerpt

This guideline has been developed to advise on the short-term management of violence and aggression in mental health, health and community settings in adults, children (aged 12 years or under) and young people (aged 13 to 17 years).

This guideline updates Violence: the Short-term Management of Disturbed/Violent Behaviour in In-Patient Psychiatric Settings and Emergency Departments (NICE clinical guideline 25), which was developed by the National Collaborating Centre for Nursing and Supportive Care and published in 2005.

Since the publication of the 2005 guideline, there have been some important advances in our knowledge of the management of violence and aggression, including service users’ views on the use of physical intervention and seclusion, and the effectiveness, acceptability and safety of drugs and their dosages for rapid tranquillisation. The previous guideline was restricted to people aged 16 years and over in adult psychiatric settings and emergency departments; this update has been expanded to include some of the previously excluded populations and settings. All areas of NICE clinical guideline 25 have been updated, and this guideline will replace it in full.

The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, people with mental health problems who have personally experienced management of violent or aggressive behaviour, their carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for the management of violence and aggression, while also emphasising the importance of the experience of these service users’ care and the experience of their carers (see Appendix 1 for more details on the scope of the guideline).

Although the evidence base is rapidly expanding, there are a number of major gaps. The guideline makes a number of research recommendations specifically to address gaps in the evidence base. In the meantime, it is hoped that the guideline will assist clinicians, service users and carers, by identifying the merits of particular treatment approaches where evidence from research and clinical experience exists.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS AND NATIONAL COLLABORATING CENTRE FOR MENTAL HEALTH (NCCMH) REVIEW TEAM
• ACKNOWLEDGMENTS
• 1. PREFACE
  • 1.1. NATIONAL CLINICAL GUIDELINES
  • 1.2. THE NATIONAL VIOLENCE AND AGGRESSION GUIDELINE
• 2. INTRODUCTION
  • 2.1. THE NEED FOR A VIOLENCE AND AGGRESSION GUIDELINE
  • 2.2. DEFINITIONS OF VIOLENCE AND AGGRESSION
  • 2.3. INCIDENCE AND PREVALENCE OF VIOLENCE AND AGGRESSION IN DIFFERENT SETTINGS
  • 2.4. THE RELATIONSHIP BETWEEN MENTAL HEALTH PROBLEMS AND VIOLENCE AND AGGRESSION
  • 2.5. SOCIAL ATTITUDES TOWARDS VIOLENCE AND AGGRESSION
  • 2.6. PERSONAL CONSEQUENCES OF VIOLENCE AND AGGRESSION FOR THE INDIVIDUAL AND FOR OTHERS
  • 2.7. CURRENT MANAGEMENT OF VIOLENCE AND AGGRESSION IN THE NHS
  • 2.8. PREDICTING THE RISK OF VIOLENCE AND AGGRESSION AND THE CULTURE OF THE NHS
  • 2.9. ECONOMIC COSTS OF VIOLENCE AND AGGRESSION TO THE NHS
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. REVIEW PROTOCOLS
  • 3.5. CLINICAL REVIEW METHODS
  • 3.6. HEALTH ECONOMICS METHODS
  • 3.7. LINKING EVIDENCE TO RECOMMENDATIONS
  • 3.8. STAKEHOLDER CONTRIBUTIONS
  • 3.9. VALIDATION OF THE GUIDELINE
• 4. RISK FACTORS AND PREDICTION
  • 4.1. INTRODUCTION
  • 4.2. REVIEW PROTOCOL
  • 4.3. RISK FACTORS FOR VIOLENCE AND AGGRESSION
  • 4.4. PREDICTION AND ANTICIPATION OF VIOLENCE AND AGGRESSION
  • 4.5. LINKING EVIDENCE TO RECOMMENDATIONS
  • 4.6. RECOMMENDATIONS
  • 4.7. RESEARCH RECOMMENDATIONS
• 5. PRE- AND IMMEDIATELY PRE-EVENT
  • 5.1. INTRODUCTION
  • 5.2. REVIEW PROTOCOL
  • 5.3. INPATIENT SETTINGS
  • 5.4. EMERGENCY DEPARTMENT SETTINGS
  • 5.5. COMMUNITY SETTINGS
  • 5.6. LINKING EVIDENCE TO RECOMMENDATIONS
  • 5.7. RECOMMENDATIONS
  • 5.8. RESEARCH RECOMMENDATIONS
• 6. DURING AND POST-EVENT
  • 6.1. INTRODUCTION
  • 6.2. REVIEW PROTOCOL
  • 6.3. DURING AN EVENT – ALL SETTINGS
  • 6.4. POST-EVENT – ALL SETTINGS
  • 6.5. LINKING EVIDENCE TO RECOMMENDATIONS
  • 6.6. RECOMMENDATIONS
  • 6.7. RESEARCH RECOMMENDATIONS
• 7. SPECIAL CONSIDERATIONS FOR CHILDREN AND YOUNG PEOPLE
  • 7.1. INTRODUCTION
  • 7.2. REVIEW PROTOCOL
  • 7.3. RISK FACTORS
  • 7.4. PREDICTION
  • 7.5. NON-PHARMACOLOGICAL MANAGEMENT STRATEGIES – ALL SETTINGS AND PHASES
  • 7.6. PHARMACOLOGICAL INTERVENTIONS – ALL SETTINGS AND PHASES
  • 7.7. LINKING EVIDENCE TO RECOMMENDATIONS
  • 7.8. RECOMMENDATIONS
  • 7.9. RESEARCH RECOMMENDATIONS
• 8. SUMMARY OF RECOMMENDATIONS
  • 8.1. PRINCIPLES FOR MANAGING VIOLENCE AND AGGRESSION
  • 8.2. ANTICIPATING AND REDUCING THE RISK OF VIOLENCE AND AGGRESSION
  • 8.3. PREVENTING VIOLENCE AND AGGRESSION
  • 8.4. USING RESTRICTIVE INTERVENTIONS IN INPATIENT PSYCHIATRIC SETTINGS
  • 8.5. MANAGING VIOLENCE AND AGGRESSION IN EMERGENCY DEPARTMENTS
  • 8.6. MANAGING VIOLENCE AND AGGRESSION IN COMMUNITY AND PRIMARY CARE SETTINGS
  • 8.7. MANAGING VIOLENCE AND AGGRESSION IN CHILDREN AND YOUNG PEOPLE
• 9. REFERENCES
• 10. ABBREVIATIONS
• APPENDICES
  • APPENDIX 1. SCOPE FOR THE DEVELOPMENT OF THE CLINICAL GUIDELINE
  • APPENDIX 2. DECLARATIONS OF INTERESTS BY GUIDELINE DEVELOPMENT GROUP MEMBERS
  • APPENDIX 3A. STAKEHOLDERS AND EXPERTS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULTATION DRAFT OF THE GUIDELINE
  • APPENDIX 3B. SPECIAL ADVISORS TO THE GUIDELINE DEVELOPMENT GROUP
  • APPENDIX 4. RESEARCHERS CONTACTED TO REQUEST INFORMATION ABOUT UNPUBLISHED OR SOON-TO-BE PUBLISHED STUDIES
  • APPENDIX 5. REVIEW QUESTIONS
  • APPENDIX 6. METHOD FOR EVIDENCE SYNTHESIS
  • APPENDIX 7. RESEARCH RECOMMENDATIONS
  • APPENDIX 8. MEDICATION INCLUDED IN THE REVIEW OF RAPID TRANQUILLISATION
  • APPENDIX 9. CLINICAL EVIDENCE – REVIEW PROTOCOLS
  • APPENDIX 10. CLINICAL EVIDENCE – SEARCH STRATEGIES
  • APPENDIX 11. CLINICAL EVIDENCE – METHODOLOGY CHECKLISTS
  • APPENDIX 12. 2005 CLINICAL EVIDENCE – STUDY CHARACTERISTICS TABLES FROM PREVIOUS GUIDELINE (CG25)
  • APPENDIX 13. CLINICAL EVIDENCE – STUDY CHARACTERISTICS TABLES (UPDATE)
  • APPENDIX 14. CLINICAL EVIDENCE – GRADE PROFILES
  • APPENDIX 15A. CLINICAL EVIDENCE – FOREST PLOTS FOR REVIEW OF RISK FACTORS
  • APPENDIX 15B. CLINICAL EVIDENCE – FOREST PLOTS FOR REVIEW OF RAPID TRANQUILLISATION
  • APPENDIX 16. HEALTH ECONOMIC EVIDENCE – SEARCH STRATEGIES
  • APPENDIX 17. HEALTH ECONOMIC EVIDENCE – COMPLETED METHODOLOGY CHECKLISTS
  • APPENDIX 18. HEALTH ECONOMIC EVIDENCE – EVIDENCE TABLES
  • APPENDIX 19. HEALTH ECONOMIC EVIDENCE – GRADE PROFILES
  • APPENDIX 20. YOUNGMINDS FOCUS GROUP REPORT